MTF Progesterone Cream
Progesterone is one of the two primary female sex hormones, the other being estrogen. The primary functions of this hormone are to regulate the menstrual cycle and support pregnancy in cis women.
In recent years, the benefits of progesterone in gender-affirming hormone therapy have been considered an innovative take on the transitioning process for trans women.
A study performed in the 1990s raised concerns that progesterone supplementation increases the risk of developing cardiovascular diseases and events such as strokes and pulmonary emboli.
However, the progesterone therapy studied included a form of progesterone that differs widely from what is used in gender-affirming care, and the population studied included cis women exclusively.
Lack of data on the health outcomes of progesterone in trans women has caused many healthcare professionals to be reluctant in prescribing progesterone.
In addition, many trans women claim that progesterone in conjunction with estradiol therapy is a crucial part of their hormone treatment regime, alleviating the anxiety that accompanies their gender dysphoria.
Since research is relatively inconclusive and the effects of progesterone vary widely between trans people and cis women, the wise route would be to talk to a medical professional and consider all variables.
The Effects Of Progesterone In Short
What Can Progesterone Do For Trans Women?
Consider the following potential outcomes while keeping in mind that research is ongoing and nothing can be assured indefinitely.
- Progesterone may cause feminization to occur more rapidly.
- It can reduce testosterone production.
- It may enhance breast development.
- It can improve bone health.
- It may improve hot flashes in menopausal women and allow for a better and deeper sleep.
- Reduction in oil production on the skin.
- Reduce male body odor.
- May reduce symptoms of stress, anxiety, and depression in trans women and postmenopausal women.
Potential Risks of Progesterone Treatment
- Progesterone may increase the risk of developing breast cancer and liver disease.
- Alter mood stability.
- Increase the risk for cardiovascular disease.
- Increased risk of strokes, blood clots, and general heart problems. Interestingly, micronized progesterone does not have these effects.
- Increased cancer risks.
Side Effects Of Progesterone Treatment
Progesterone may cause:
- Nausea and vomiting
- Diarrhea
- Fatigue
- Mood swings
- Irritability
- Anxiety
- Coughing and sneezing
- Constipation
- Problems with initiating urination
The Role Of Progesterone
Normal Natal Female Breast Development
Natal female breast development is initiated during female puberty, typically preceding the onset of menstruation.
Breast development occurs in five anatomical phases referred to as the « Tanner Stages. » These stages are based on the structural changes of the nipples and breasts.
Two main tissue types are involved in breast development. These tissues include milk-producing ducts, called the lobular, and milk delivery tissue, called ductwork. The lobular tissue consists of clusters of acini, which are milk-producing structures. Acini are alternatively referred to as alveoli.
During the first four stages of the Tanner Stages, breast growth is stimulated and mediated by the influences of estrogen on the ductwork tissue. Tanner Stage five continues into early adulthood and may sometimes not be entirely completed until pregnancy.
Progesterone starts to surge in monthly intervals when menstruation commences and influences the development of the lobular structures. Progesterone levels increase during the second half of the menstrual cycle, being secreted by the corpus luteum and other body organs. The corpus luteum is the remainder of the follicle containing the egg cell that is released by the ovary.
The function of progesterone is to prepare the uterine lining for the implantation of an embryo. When, in fact, a woman is pregnant, a longer surge of heightened progesterone levels persists to maintain the uterine lining as well as promote breast development and increase breast size in preparation for nursing.
Similar to the outcomes of estrogen therapy, progesterone treatment acts as a testosterone blocker in trans women. This occurs as the result of a feedback mechanism in the brain responsible for regulating testosterone levels.
Anti-Progesterone Argument
A clinical article prepared by Doctor Richard Curtis of the London Gender Clinic in 2009 describes the connection between progesterone and breast development. In this article, a firm stance against the use of progesterone for breast development is maintained.
Dr. Curtis argues that trans women and cis women alike have to be satisfied with the breast size brought on by estrogen therapy and testosterone blockers alone. According to him, the risks far surpass the benefits of progesterone treatment, and the minor contribution it may offer is not worth it.
Curtis states that if trans women wish to increase their breast size, they should do so by increasing their overall body fat percentage or consider getting breast augmentation surgery and breast implants.
The article presents a list of reasons why progesterone is not an appropriate inclusion in transgender women’s therapy.
- The first surge in progesterone levels only occurs after Tanner Stage 5 of breast development. Consequently, progesterone does not promote breast development as Stage 5 is the last stage.
- Natal breast development achieved by Tanner Stage 5 results in approximately the same cup size that hormone therapy in trans women brings about.
- The side effects of progesterone treatment are undesirable and unnecessary.
- Adding progesterone to a hormone therapy regime antagonizes the effects of estrogen on breast growth.
- Genes determine the number of estrogen receptors a person has, thereby ultimately determining the breast size.
- Progesterone primarily impacts the size of the lobular tissue. However, lobular tissue is much smaller than ductal tissue, which grows as a result of estrogen.
- Because trans women will never be able to breastfeed, progesterone as a means of increasing breast size is unnecessary.
- Some common reasons for wanting to attempt progesterone treatment include the desire to experience the same effects as menstruating cis women. This is not a medically valid reason for commencing a treatment that may be harmful to your health.
- With menstruation typically ceasing at age 50 and the average age of actively transitioning trans women being 42, transgender women would not benefit from progesterone treatment.
- Progesterone can cause weight gain in transgender women.
Pro-Progesterone Argument
The following argument and interpretation of the effects of progesterone are based on the unique properties of progesterone and not synthetic progestins, which carry distinctly different side effects and distinctly outcomes from progesterone.
More rapid feminization
Progesterone is a natural competitor for the 5-alpha reductase enzyme responsible for converting testosterone into DHT, which causes masculinization of hair follicles and the skin. Progesterone thus reduces the masculinizing effects of DHT.
More often than not, trans people seek higher doses of estrogen because of the presence of masculine traits taking too long to cease. Many study groups have proven to experience more rapid feminization when receiving progesterone in addition to estrogen therapy and antiandrogens. This is especially applicable to male to female alterations in hair growth patterns.
Benefits for Sleep, Anxiety, and Mental Health for Trans People
As members of the LGBTQA+ community are generally more prone to suffering from depression and anxiety, progesterone could be very beneficial in alleviating these symptoms.
In addition to the stresses associated with transitioning, trans people also face unique challenges in sociological aspects. The beneficial effects of progesterone on stress have the potential to improve the mental health status of many trans patients.
In terms of clinical endocrinology, progesterone metabolites have proven to improve sleep parameters.
Beneficial For Bone Health
Progesterone has been found to have advantageous effects on bone strength and consistency by increasing the number of mature osteoblasts and thereby the creation of a collagen bone matrix that will eventually be mineralized.
Although most studies are focused on the effects of progesterone on menopausal women, both estrogen and progesterone are known to have protective effects on bone mass regardless of gender and age groups.
Nonetheless, evidence suggests that progesterone can drastically decrease the risk of osteoporosis in cis women.
Conclusion
After thoroughly researching and evaluating one’s individual physiology, progesterone can have many long-lasting benefits on the health of a trans woman and cis woman alike.
Oral micronized progesterone is a fundamental ovarian steroid that benefits bone health and potentially presents protective effects against cardiovascular disease, although research is still ongoing and inconclusive.
Progesterone will further support the effects of testosterone blockers, thereby enhancing the feminizing effects of both estrogen and antiandrogens. Progesterone cream may also promote the acceptance and utilization of estrogen in the bodies of trans people.
It is worth taking the negative effects of progesterone into account. Mood swings and increased risk of cardiovascular adverse events may occur when adding progesterone to your HRT treatment regime.
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